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Progressive polyradiculoneuropathy due to intraneural oxalate deposition in type 1 primary hyperoxaluria.
[primary hyperoxaluria type 1]
Introduction
:
A
24
year
old
man
with
primary
hyperoxaluria
type
1
(
PH
1
)
presented
with
a
rapidly
progressive
axonal
and
demyelinating
sensorimotor
polyradiculoneuropathy
shortly
after
the
onset
of
end
stage
renal
disease
.
His
plasma
oxalate
level
was
markedly
elevated
at
107
µmol
/
L
(
normal
:
<
1
.
8
µmol
/
L
)
.
Methods
:
A
sural
nerve
biopsy
was
performed
.
Teased
fiber
,
paraffin
and
epoxy
sections
,
and
morphometric
procedures
were
performed
on
this
sample
and
on
an
archived
sample
from
a
22
year
old
man
as
an
age-
and
gender-matched
control
.
Embedded
teased
fiber
electron
microscopy
was
also
performed
.
Results
:
The
biopsy
revealed
secondary
demyelination
and
axonal
degeneration
.
Under
polarizing
light
,
multiple
bright
hexagonal
,
rectangular
,
and
starburst
inclusions
typical
of
calcium
oxalate
monohydrate
crystals
were
seen
(
1
,
2
,
3
)
.
Discussion
:
Proposed
mechanisms
of
nerve
damage
include
disruption
of
axonal
transport
due
to
crystal
deposition
,
toxic
effect
of
oxalate
,
or
nerve
ischemia
related
to
vessel
occlusion
from
oxalate
crystal
deposition
.
©
2014
Wiley
Periodicals
,
Inc
.
Diseases
Validation
Diseases presenting
"demyelination"
symptom
adrenomyeloneuropathy
alexander disease
canavan disease
classical phenylketonuria
homocystinuria without methylmalonic aciduria
kallmann syndrome
krabbe disease
locked-in syndrome
neonatal adrenoleukodystrophy
neuralgic amyotrophy
primary hyperoxaluria type 1
pyruvate dehydrogenase deficiency
sneddon syndrome
waldenström macroglobulinemia
wiskott-aldrich syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
This symptom has already been validated